Paediatrics Flashcards
At what age can a child sit without support?
6-8m (LA: 12m)
At what age will a child begin to walk?
12m (LA: 18m)
At what age can a child run?
2.5y
At what age can a child ride a tricycle?
3y
At what age can a child hop and skip?
4y and 5y respectively
At what age will a child follow a moving object by turning their head?
6w (LA: 3m)
At what age will a child reach out for a toy?
4m (LA: 6m)
At what age does a child develop a mature pincer grip?
10m (LA: 12m)
At what age can a child build a tower of 3 blocks?
18m
At what age can a child build a bridge of blocks?
3y
A what age can a child draw a line?
2y
A what age can a child draw a circle?
3y
A what age can a child draw a square?
4y
A what age can a child draw a triangle?
5y
At what age will a child start to use the words mama or dad?
7-10m
At what age can a child join words to make simple phrases?
20-24m
At what age can a child understand their name?
12m
At what age can a child smile reponsively?
6w (LA: 10w)
At what age can a child wave bye bye?
10-12m
At what age can a child drink from a cup?
12m
At what age can a child use a spoon?
18m
At what age will a child start to take turns when playing?
2.5-3y
How long is age corrected for prematurity when considering milestones?
2 years
What is the moro reflex?
Head extension causes abduction followed by adduction of the arms, till 3-4 months
What is the grasp reflex?
Flexion of fingers when object placed in palm, till 4-5 months
What is colic?
Paroxysmal crying with pulling up of legs for >3h on ≥3days/week.
What are some features of cow’s milk protein allergy?
Colic symptoms, GORD, blood/mucus in stools,
eczema, faltering growth
How should cow’s milk protein allergy be managed?
Exclude cow’s milk from mother diet or use extensive hydrolysed/amino acid formula
How does ammonia dermatitis (nappy rash) present?
Red desquamating rash, sparing skin folds, due to
moisture retention
How should ammonia dermatitis (nappy rash) be treated?
Frequent nappy changes, nappy free periods, careful drying and emollient creams
What can cause vomiting in infancy?
Regurg during feeds (posseting) or between feeds
GORD
Overfeeding (150ml/kg/day normal)
Pyloric stenosis – projectile, 6-10 weeks old
Infections
Adverse food reactions – allergies, coeliac
What can cause bilous vomiting in infancy?
Duodenal obstruction, volvulus
What are some lung complications of mechanical ventilation?
Pneumothorax
Pulmonary haemorrhage
Bronchopulmonary dysplasia
Pneumonia
What are some airway complications of mechanical ventilation?
Upper airway obstruction, GORD, laryngomalacia
What are some non-respiratory complications of mechanical ventilation?
PDA, RICP
Retinopathy of prematurity
Subcutaneous emphysema
Air in mediastinum, pericardium, peritoneum due to air leak (ruptured alveoli)
What is the definition for preterm?
<37 weeks
What is the defintion for low birth weight? Very low birth weight? Extremely low birth weight?
L: <2500g
VL: <1500g
EL: <1000g
What is symmetric IUGR? And what are some causes?
All growth parameters are symmetrically small suggesting fetus was affected from early pregnancy Chromosomal abnormalities and constitutionally small
What is asymmetric IUGR? And what is a cause?
Weight centile is less than length and head circumference
Pre-eclampsia
What is Hirschsprung’s disease?
Congenital absence of ganglia in a segment of colon leading to functional GI obstruction, constipation and
megacolon
How is Hirschsprung’s diagnosed?
Rectal suction biopsy of aganglionic section staining for
acetylcholinesterase positive nerve excess
How is Hirschsprung’s treated?
Bowel irrigation and surgery
What are some complications of Hirschsprung’s?
GI perforation, bleeding, ulcers, enterocolitis
What are some signs of oesophageal atresia + trachea-oesophageal fistula?
Polyhydramnios Cough Airway obstruction Increased secretions Distended abdo Cyanosis Aspiration
How should oesophageal atresia + trachea-oesophageal fistula be treated?
Stopping feeding, suck out oesophageal pouch and surgery
Describe the features of congenital diaphragmatic hernia:
Developmental defect (left pos. diaphragm) allowing herniation of abdo contents into chest
What are some signs of congenital diaphragmatic hernia?
Respiratory distress, bowel sounds over hemithorax, cyanosis
How should congenital diaphragmatic hernia be treated?
Large bore NGT to remove air from gut and then surgery
What are some complications of inguinal hernia?
Obstruction, incarceration, strangulation
When should an inguinal hernia be operated on in a baby <6w, child <6m and child <6y?
Within 2d
Within 2w
Within 2m
What is Meckel’s diverticulum?
Remnant of the omphalomesenteric duct in small intestine and contains ectopic ileal, gastric or pancreatic mucosa
How can Meckel’s diverticulum present?
Asymptomatic, abdo pain, rectal bleeding, intestinal obstruction
What is gastroschisis?
Paraumbilical defect with extrusion of viscera and abdo contents with no covering
What is the management for gastroschisis?
Cover exposed bowel in clingfilm, keep baby warm and hydrated and close defect ASAP
What is exomphalos?
Ventral defects of umbilical ring with herniation of abdo viscera covered in peritoneum
What are the consequences of congenital diaphragmatic hernia?
Leads to impaired lung development (hypoplasia and pulmonary HTN)
How should undescended testis be managed?
Orchidopexy
What can cause oligohydramnios prenatally and absent/feeble voiding postnatally?
Posterior urethral valves
What is hypospadias?
Abnormal position of external urethral meatus on ventral penis
How should hypospadias be managed?
Use foreskin for preschool repair
What is patent urachus?
Opening between bladder and navel, urine leaks from umbilicus
What is bladder exstrophy?
Extrusion of bladder through defect in abdo wall
What is the commonest renal tumour in children?
Wilms’ nephroblastoma
How can Wilms’ nephroblastoma present?
Before 4yrs with painless, palpable abdo mass
Fever, flank pain
What is the management for Wilms’ nephroblastoma?
Nephrectomy with neo-adjuvant chemo
What is the pathophysiology of congenital adrenal hyperplasia?
Deficiency of 21-hydroxylase.
Cortisol not produced so rise of ACTH, adrenal hyperplasia and overproduction of androgenic cortisol precursors leading to increased testosterone
What are some signs of congenital adrenal hyperplasia?
Vomiting, dehydration, ambiguous genitalia
Boys may have precocious puberty or incomplete masculinisation
Growth and fertility impairment
What is the management for congenital adrenal hyperplasia?
Glucocorticoid replacement in all, mineralocorticoid replacement if salt-wasting
What are some signs of an adrenal crisis?
N+V, abdo pain, lethargy, hypotension
What is the management for an adrenal crisis?
Hydrocortisone IV, saline IVI, glucose, fludrocortisone
What are some causes of cleft lip and palate?
Genes, benzodiazepines, antiepileptics, rubella
How can cleft lip and palate be managed?
Feeding with special teats
Plastic surgery (lip at 3 months, palate at 6)
Speech therapy
What is spina bifida? What are the 3 types?
Incomplete closing of spine and meninges during development
3 types: spina bifida occulta, meningocele, myelomeningocele
What is meningocele? What is myelomeningocele?
Herniation of dura and arachnoid mater through bony defect
If involving cord, myelomeningocele
How can neural tube defects be prevented?
0.4mg folic acid daily from 3 months preconception to 13 weeks gestation
If high risk, 5mg
What are some features seen in fetal alcohol syndrome?
Short palpebral fissure Hypoplastic upper lip Smooth/absent philtrum Learning difficulties Microcephaly Growth retardation
What is Eisenmenger’s syndrome?
Increased pulmonary resistance causes reversal of left to right flow through shunt
How can ASD and VSD be managed?
Small defects can close spontaneously
Larger may need patch surgery
Describe some features you may elicit if a pt has a PDA:
Continuous machine murmur below left clavicle, collapsing pulse
How should PDA be managed?
Ensure no duct dependent circulation by echo
Treat with oral or IV ibuprofen
What are some features of coarctation of the aorta?
HTN, radio-femoral delay, ejection systolic murmur at ULSE
How should coarctation of the aorta be managed?
Stent or surgery by 5 years
How should TGA be managed?
Maintain PDA, balloon catheter atrial septal perforation, surgery with arterial switch
What are the defects in tetralogy of Fallot?
Large VSD, overriding aorta, pulmonary stenosis, RVH
What can cause innocent murmurs in children?
Fever, anxiety, exercise
Describe the classification of murmurs:
- Just audible
- Quiet but easily audible
- Loud, no thrill
- Loud with thrill
- Audible even if stethoscope makes partial contact with skin
- Audible without stethoscope
What are the steps in the management of cyanotic spells?
Place child in knee to chest position O2 through non-rebreather Morphine Fluid bolus Propanolol, adrenaline
What are some of the main causes of HTN in children?
Renal parenchymal disease (80%)
Renal vascular disease, COA, endocrine, essential HTN
What are some investigations that should be performed in a child has HTN?
Urine for albumin and blood U+Es, creatinine, FBC Renal US Fasting lipids, glucose ECG, echo
What are some signs of infective endocarditis?
Fever, splenomegaly, clubbing, splinter haemorrhages, anaemia, rash, HF, microscopic haematuria, new murmur
What are the main causative organisms of infective endoccarditis?
Streps, staphs
What investigations should be done if infective endocarditis is suspected?
Blood cultures (different times, different sites), echo
What treatment should be given for infective endocarditis?
Benpen + gentamicin
What is rheumatic fever?
Systemic febrile illness caused by a cross-sensitivity reaction to group A betahaemolytic strep and may result in permanent heart valve damage
What diagnostic criteria is used in rheumatic fever?
Jones diagnostic criteria
What are is the management of rheumatic fever?
Rest, aspirin, prednisolone and penicillin (pharyngitis)
What are the features of Kawasaki disease?
Conjunctivitis Rash Adenopathy (cervical LNs) Strawberry tongue Hands (palmar erythema) And Burn (fever for >5 days)
How should Kawasaki disease be treated?
High-dose aspirin, IV immunoglobulin, echo (screening test for coronary artery aneurysms)
What are the main causes of stridor?
Viral croup, bacterial tracheitis, epiglottitis, foreign body, laryngomalacia
What are the signs of croup?
Stridor, barking cough, hoarseness
What are the main causative organisms of croup?
Parainfluenza virus (1, 2, 3) Respiratory syncytial virus, measles
What is the management for mild croup?
Sent home if settles with dexamethasone
What is the management for severe croup?
Nebulised adrenaline and high flow O2, and if fails take to ITU
How can croup and bacterial tracheitis be differentiated?
Bacterial tracheitis often affects those >6y
Continuous stridor as opposed to stridor when upset
High fever in BT
What is the main causative organism in epiglottitis?
Haemophilus influenzae B
What is the management for epiglottitis?
Take child to theatre for inhalation induction of anaesthesia and EUA if necessary
Cefotaxime
What are some features of epiglottitis?
Sudden onset, continuous stridor, drooling of secretions, fever, cough not prominent
What are some symptoms of tonsillitis?
Pain on swallowing, fever, tonsillar exudate, cough, earache
How should need for antibiotics in tonsillitis be decided?
Centor or FeverPAIN
If needed, how long should antibiotics be given for in tonsillitis?
10d
What are some symptoms of otitis media?
Otalgia, irritability, decreased hearing, poor feeding, fever
Bulging, erythematous tympanic membrane
What are some causes of snoring in children?
Obesity, nasal polyps, deviated septum, recurrent tonsillitis, Down’s, hypothyroidism
What are some features of acute bronchiolitis?
Coryza, cough, fever, tachypnoea, wheeze, inspiratory crackles, apnoea, intercostal recession
What are the main causative organisms of acute bronchiolitis?
RSV
Mycoplasma, parainfluenza, adenovirus
What signs of acute bronchiolitis mean the child may need admitting?
Inadequate feeding, resp distress (grunting, recessions), hypoxia, cyanosis
What is the management for acute bronchiolitis?
O2 (stop when 92%)
Nasogastric feeds
May need CPAP
What are some features of pneumonia?
Fever, malaise, poor feeding, tachypnoea, cyanosis, grunting, recessions, accessory muscles
Older children may get pleural pain, crackles, bronchial breathing
What are the main causative organisms of pneumonia?
Pneumococcus, mycoplasma, haemophilus, staph, TB, viral
What signs of pneumonia mean the child may need admitting?
O2 <92%, signs of resp distress
What investigations should be performed if pneumonia is suspected?
CXR, FBC, sputum culture
What is the management for pneumonia?
Abx - oral amoxicllin
What are some signs of TB in children?
Anorexia, low fever, failure to thrive, malaise, cough
What investigations should be performed if TB is suspected?
Tuberculin tests
Interferon gamma release assays
Culture and Ziehl-Neelsen stain of sputa (x3)
CXR
What is the causative organism of whooping cough?
Bordetella pertussis
What ages of children does whooping cough typically affect?
Infants and 2nd peak in those >14y
What are some signs of whopping cough?
Apnoea, bouts of coughing ending with vomiting, worse at night or after feeds
How long do symptoms typically last in whooping cough?
10-14 weeks
What investigations should be performed if whooping cough is suspected?
PCR via nasal swab, culture, FBC (absolute lymphocytosis)
What are some complications of whooping cough?
Petechiae, conjunctivital, retinal and CNS bleeds
Apnoea
Inguinal hernias
What are some management options for whooping cough?
Admit if <6 months, may need ventilation Clarithromycin to stop spread (after 3w not infective)
Describe the features of viral induced wheeze:
Usually >6m with cough and wheeze
Symptoms vary from hour to hour
No symptoms in between episodes
What may be the management for viral induced wheeze?
May benefit from inhaled beta-2-agonists
What are some causes of acute wheeze in children?
Asthma, viral wheeze, bronchiolitis, atypical pneumonia, foreign body inhalation, anaphylaxis
What are some causes of recurrent/persistent wheeze in children?
Asthma, broncho-pulmonary dysplasia, CF,
bronchiectasis, recurrent aspiration, vocal cord dysfunction, structural abnormality
What is the cause of cystic fibrosis?
Mutations (F508) in cystic fibrosis transmembrane
conductance regulator gene (CFTR) on chromosome 7, coding a cyclic AMP regulated Na/Cl channel
How are newborns screened for cystic fibrosis?
Screened for an abnormally raised immunoreactive trypsinogen and 29 CTFR mutations
List the cut off values for the sweat test for CF:
Sweat Cl - >60mmol/L support diagnosis
<40mmol/L is normal and intermediate results are suggestive
How can CF present?
Meconium ileus, recurrent pneumonia, failure to thrive, slow growth, steatorrhea
What respiratory organisms typically affect those with CF?
S. aureus, H. influenzae, S. pneumonia, pseudomonas aeruginosa
How can respiratory problems in CF be managed?
Start physio (3x a day) at diagnosis
Teach parents percussion and postural drainage
Treat infections aggressively
Describe the recommended diet in CF:
High calorie, high protein and high fat with Vit A and D
What medications can be given to help GI absorption in CF?
Pancrex V/Creon
Omeprazole
What is meconium ileus?
Failure to pass stool or vomiting in first 2 days of life
What is the management for meconium ileus?
NGT drainage, washout enemas, excision of gut containing most meconium
What are some complications associated with CF?
Impaired glucose tolerance, bronchiectasis, cirrhosis,
cholesterol gallstones, male infertility
Name some triggers for asthma:
Pollen, house dust mite, fur, exercise, chemicals, smoke, traffic, cold air, NSAIDs, beta blockers
What are some investigations for suspected asthma?
Spirometry, peak flow, exhaled NO, exercise testing, skin prick
Describe the step-wise treatment for asthma:
- PRN salbutamol. If need >3x per week or asthma
wakes from sleep >1 per week, add step 2. - Add inhaled steroid e.g. beclomethasone
- If <5y, add 1 evening dose of montelukast 4mg. If >5y can try inhaled salmeterol (LABA). If symptomatic increase ICS and add montelukast or theophylline
- Refer to specialist
- Add prednisolone at lowest dose
Describe the treatment for severe asthma:
High flow O2 Salbutamol nebs Hydrocortisone IV IV magnesium sulfate Aminophylline IV ITU if exhausted or needing IV salbutamol
What are the defining features of acute severe asthma?
PEFR 33-50%, inability to complete sentences, use of
accessory muscle, tachypnoea, tachycardia
What are the defining features of life-threatening asthma?
Resp acidosis, mechanical ventilation. PEFR <33%, sats
<92%, silent chest, cyanosis, poor resp effort,
bradycardia, hypotension, exhaustion
What type of viruses are measles, mumps and rubella?
RNA viruses
What are the features of measles infection?
Cough, coryza, conjunctivitis, cranky, increased temp, Koplik spots on palate, rash (behind ears then spreads down body)
What are some complications of measles infection?
Otitis media, croup, tracheitis, pneumonia
Subacute sclerosing panencephalitis (7-13y later)
How are viral infections such as MMR treated?
Ensure adequate nutrition and hydration (NGT if poor feeding)
Continue breastfeeding
Treat any secondary bacterial infections
Which of measles, mumps, rubella and scarlet fever are notifiable diseases?
All of them
What are the features of rubella infection?
Macular rash (starts on face), suboccipital lymphadenopathy
What are the features of mumps infection?
Prodromal malaise, increased temp., painful parotid swelling
What is the causative organism of slapped cheek/fifth disease?
Parvovirus B19
What are the features of Parvovirus B19 infection?
Malar erythema (slapped cheek), gloves and socks rash, lethargy, fever
What is the causative organism of hand, foot and mouth disease?
Coxsackie virus A16
What is the causative organism of roseola infantum?
Herpes virus 6
What are the features of roseola infantum?
Increased temp. then a maculopapular rash, uvulo-palatoglossal junctional ulcers (Nagayama spots)
What is the cause of scarlet fever?
Reaction to erythrogenic toxins produced by Group A haemolytic strep (S. pyogenes)
What are the features of scarlet fever?
Fever, malaise, headache, strawberry tongue, fine punctuate erythema on torso sparing palms and soles
What is the treatment for scarlet fever?
Pen V for 10 days
What are the complications of scarlet fever?
Otitis media, rheumatic fever, glomerulonephritis
What are the features of chickenpox?
Crops of skin vesicles often starting on face, scalp or trunk. Rash is more concentrated on torso
When does chickenpox stop becoming infective?
Once lesions have scabbed over
Describe the course of a chickenpox infection:
fever, rash 2 days later (macule -> papule -> vesicle -> ulcers -> crusting)
What are some dangerous contexts for chickenpox infection?
Immunosuppression, CF, severe eczema, neonates
What is the general management for chickenpox?
Calamine lotion soothes, trim nails, daily antiseptic
What is the management for chickenpox in dangerous context (e.g. immunosuppression)?
Antivaricella-zoster immunoglobulin and acyclovir, started within 7 days of rash
When should heel-prick test (blood spot screening) be performed?
5-9 days of life
What is the purpose of heel-prick test (blood spot screening)?
P.S. name at least 5 conditions
Screening for: congenital hypothyroidism, CF, sickle cell, PKU, medium chain acyl-CoA dehydrogenase deficiency, maple syrup urine disease, isovaleric
acidaemia, glutaric aciduria type 1, homocystinuria
Describe the newborn examination, including the 4 key areas to examine:
Focuses on heart (murmurs), eyes (red reflex – retinoblastoma and cataracts), hips (dislocation) and testes (undescended)
Also birth marks, spinal defects, head circumference,
cleft palate, abdo masses
Describe the newborn hearing test:
Otoacoustic emission test
If 2 abnormal tests refer for auditory brainstem response test
What are contraindications to live vaccines?
Acute febrile illness is a contraindication to any vaccine
Primary immunodeficiency or on steroids